Related Experiment Videos
Large artery vasculopathy in HIV-positive patients: another vasculitic enigma
1Department of Pathology, University of Natal School of Medicine, Durban, South Africa.
Insights
Large vessel disease, including aneurysms and occlusive conditions, affects young patients with human immunodeficiency virus (HIV) infection. This vasculopathy is linked to leukocytoclastic vasculitis of vasa vasora and periadventitial vessels.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Pathology
Background:
- Human immunodeficiency virus (HIV) infection commonly affects multiple organ systems.
- Cardiovascular complications, particularly small to medium-sized vessel vasculitis, are recognized in HIV patients.
- Large vessel disease in young HIV-positive individuals is less frequently described.
Purpose of the Study:
- To describe the clinical presentation, arterial involvement, and histopathological findings of large vessel disease in a cohort of young HIV-positive patients.
- To investigate the potential causes and pathogenetic mechanisms of this vasculopathy.
Main Methods:
- Retrospective case series of 16 HIV-positive patients with large vessel disease.
- Clinical data review including patient demographics, presenting symptoms, and affected arteries.
- Histopathological examination of affected arterial segments.
- Microbiologic cultures and serological tests for syphilis.
Main Results:
- Sixteen HIV-positive patients (9 male, 7 female; age 18-38 years) presented with large vessel disease, including aneurysms (1-7 lesions) and occlusive disease.
- Affected arteries included the aorta, carotid, iliac, femoral, and popliteal arteries.
- Histology revealed leukocytoclastic vasculitis of vasa vasora and periadventitial vessels, chronic inflammation, fibrosis, and medial/intimal changes.
- Staphylococcus aureus was cultured in one case; syphilis serology was positive in one patient.
Conclusions:
- Large vessel vasculopathy, predominantly aneurysmal, is a significant cardiovascular complication in young HIV-positive patients.
- The findings suggest an infective or immune complex-mediated origin.
- Leukocytoclastic vasculitis of the vasa vasora and periadventitial vessels appears pivotal in the pathogenesis.
Abstract:
Human immunodeficiency virus (HIV) infection has impacted on all the systems of the body, and the cardiovascular system is no exception, with small to medium-sized vessel vasculitis being most frequently described. We present 16 HIV-positive patients with large vessel disease consisting of either aneurysms (often multiple) or occlusive disease. Nine men and 7 women ranging in age from 18 to 38 years presented with rupture of aneurysm, transient ischemic attacks, hypertension, ischemia to the lower extremity, or a mass at the site of the aneurysm. Eight patients had 1 aneurysm, 2 had 2 lesions, and the remaining 6 cases had from 3 to 7 aneurysms. Arteries affected included the common carotid, abdominal aorta, common iliac, femoral, and popliteal. Three patients had intercurrent infections, but none had any obvious infective vascular lesion. Only 1 patient had a positive TPHA test for syphilis. Microbiologic culture of both blood and thrombus contents was positive for Staphylococcus aureus in 1 case; no other organisms were cultured. The key histological features were within the adventitia: leukocytoclastic vasculitis of the vasa vasora and periadventitial vessels, proliferation of slit-like vascular channels, chronic inflammation, and fibrosis. There was associated medial fibrosis with loss and fragmentation of muscle and elastic tissue. Intimal changes consisted of duplication and fragmentation of the internal elastic lamina with calcification. Atheroma and marked intimal thickening were not evident We believe that the occurrence of this large vessel vasculopathy (mainly aneurysmal) often with multiple lesions in young HIV-positive patients, is characteristic of possible infective or immune complex origin, with leukocytoclastic vasculitis of vasa vasora and periadventitial vessels being pivotal in many cases.